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Induced arterial hypotension for interventional thoracic aortic stent-graft placement: impact on intracranial haemodynamics and cognitive function

  • G. von Knobelsdorff (a1), R. M. Höppner (a1), P. H. Tonner (a1), A. Paris (a1), C. A. Nienaber (a2), J. Scholz (a1) and J. Schulte am Esch (a1)...


Background and objective: The study investigated the impact of induced arterial hypotension for the facilitation of endovascular stent-graft placement in patients with thoracic aortic aneurysm on cerebral blood flow velocity and neurological/neurocognitive outcome.

Methods: In 27 ASA III patients, cerebral blood flow velocity was recorded during induced arterial hypotension for endovascular stent-graft placement using transcranial Doppler sonography and the Folstein Mini Mental State Examination and the National Institute of Health Stroke Scale were performed before and after the intervention.

Results: Mean arterial pressure was decreased <50 mmHg, and in 22 patients it was <40 mmHg. Diastolic cerebral blood flow velocity decreased by 59%. Postoperatively, six of 21 patients exhibited changes in the Folstein Mini Mental State Examination and four of these six patients in the National Institute of Health Stroke Scale as indices of new-found neurocognitive dysfunction, but there were no signs of stroke. Loss of the diastolic blood flow profile was detected in two of six patients with new-found neurocognitive dysfunctions and in 18 of 21 patients with no new-found neurocognitive dysfunction. Changes in the Folstein Mini Mental State Examination on postoperative day 1 were correlated to the pre-procedural Folstein Mini Mental State Examination, but not to the time spent with a mean arterial pressure <50 mmHg, <40 mmHg or with a loss of diastolic blood flow profile.

Conclusions: Transcranial Doppler sonography visualizes the individual effect of induced hypotension and the period of intracranial circulatory arrest during aortic stent-graft placement. However, transient new-found neurocognitive dysfunctions occur independently of the transcranial Doppler data, and are in close correlation to the neurocognitive state before the procedure. The results suggest that induced arterial hypotension is not the major factor for postoperative new-found neurocognitive dysfunction.

Corresponding author
Correspondence to: Georg von Knobelsdorff, Department of Anaesthesia and Intensive Care Medicine, St Bernward Hospital, D-31134 Hildesheim, Germany. E-mail:; Tel: +49 5121 90 5424; Fax: +49 5121 90 1244
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Dake MD, Kato N, Mitchell RS, et al. Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 1999; 340: 15461552.
Kato N, Dake MD, Miller DC, et al. Traumatic thoracic aortic aneurysm: treatment with endovascular stent-grafts. Radiology 1997; 205: 657662.
Nienaber CA, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. N Engl J Med 1999; 340: 15391545.
Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Liddell RP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med 1994; 331: 17291734.
Baker AB, Bookallil MJ, Lloyd G. Intentional asystole during endoluminal thoracic aortic surgery without cardiopulmonary bypass. Br J Anaesth 1997; 78: 444448.
Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’ a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189198.
Tombaugh TN, McIntyre NJ. The mini-mental state examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922935.
Grace J, Nadler JD, White DA, et al. Folstein vs modified mini-mental-state examination in geriatric stroke. Arch Neurol 1995; 52: 477484.
Wityk RJ, Pessin MS, Kaplan RF, Caplan LR. Serial assessment of acute stroke using the NIH stroke scale. Stroke 1994; 25: 362365.
Biedler A, Juckenhöfel S, Larsen R, et al. Postoperative Störungen der kognitiven Leistungsfähigkeit bei älteren Patienten. Anaesthesist 1999; 48: 884895.
Roach GW, Kanchuger M, Mora-Mangano C, et al. Adverse cerebral outcomes after coronary bypass surgery. N Engl J Med 1996; 335: 18571863.
Mitchell RS, Dake MD, Semba CP, et al. Endovascular stent-graft repair of thoracic aortic aneurysms. J Thoracic Cardiovasc Surg 1996; 111: 10541062.
Albanese MA, Clarke WR, Adams HP, Woolson RF, TOAST investigators. Ensuring reliability of outcome measures in multicenter clinical trials of treatments for acute ischemic stroke. Stroke 1994; 25: 17461751.
Shaw PJ, Bates D, Cartlidge NE, et al. Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke 1987; 18: 700707.
Murkin JM, Martzke JS, Buchan AM, Bentley C, Wong CJ. A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery: (part II) neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 1995; 110: 349362.
Kontos HA, Wei EP, Navari RM, Levasseur JE, Rosenblum WI, Patterson JL. Responses of cerebral arteries and arterioles to acute hypotension and hypertension. Am J Physiol 1978; 234: H371H383.
Dahl A, Russel D, Nyberg-Hansen R, Rootwelt K. Effect of nitroglycerin on cerebral circulation measured by transcranial Doppler and SPECT. Stroke 1989; 20: 17331736.
Werner C, Hoffman WE, Koch E, Albrecht RF, Schulte am Esch J. Transcranial Doppler sonography indicates critical brain perfusion during hemorrhagic hypotension in dogs. Anesth Analg 1995; 81: 12031207.
Lam AM. Change in cerebral blood flow velocity pattern during induced hypotension: a non-invasive indicator of increased intracranial pressure? Br J Anaesth 1992; 68: 424428.
Wheat MW. Current status of medical therapy of acute dissecting aneurysms of the aorta. World J Surg 1980; 4: 563569.
Glower DD, Fann JI, Speier RH, et al. Comparison of medical and surgical therapy for uncomplicated descending aortic dissection. Circulation 1990; 82: IV39IV46.
Kahn RA, Marin ML, Hollier L, Parsons R, Griepp R. Induction of ventricular fibrillation to facilitate endovascular stent-graft repair of thoracic aortic aneurysms. Anesthesiology 1998; 88: 534536.
Weigand MA, Motsch J, Bardenheuer HJ, Kahn RA, Marin ML, Hollier LH. Adenosine-induced transient cardiac arrest for placement of endovascular stent-grafts in the thoracic aorta. Anesthesiology 1998; 89: 1037.
Wiegand MA, Schumacher H, Allenberg JR, Bardenheuer HJ. Adenosin-induzierter Herzstillstand zur endovasculären Rekonstruktion von thorakalen Aortenaneurysmen. Anästhesiol Intensivmed Notfallmed Schmerzther 1999; 34: 372375.
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European Journal of Anaesthesiology
  • ISSN: 0265-0215
  • EISSN: 1365-2346
  • URL: /core/journals/european-journal-of-anaesthesiology
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